New ‘End of Life Care in Frailty’ guidelines have been published by the British Geriatrics Society to help doctors, nurses and allied health professionals provide high-quality, person-centred care for older people approaching the end of their lives, both during the pandemic and in the future. The guidelines aim to improve end-of-life care for all older people with frailty, not just those diagnosed with Covid.
The planning and delivery of good end-of-life care, magnified as a key issue for healthcare professionals caring for older patients during the COVID-19 pandemic, is explored in-depth in the new guidelines. Covering the final year of life in people living with frailty, the guidelines address issues such as uncertainty faced by patients and their families, advance care planning, law and ethics, as well as management of common symptoms at the end of life such as pain, delirium, incontinence, and swallowing difficulties. A key aim of this new guidance is to prompt and support timely discussions about preferences for care with the older person themselves and their family.
The guidelines also cover the unique considerations applicable in specific settings, such as urgent care, care homes, and prisons. They explore issues such as cultural and spiritual needs, and the importance of social and psychological support. The guidelines are the result of 18 months of work involving more than 30 contributors with expertise in a wide range of issues that affect older people towards the end of life.
Co-editor of the guidelines, Dr Eileen Burns, commented: ‘Too often the clinical response to an acute deterioration in a frail older person is protocol or pathway driven, especially during an unprecedented crisis such as the one we are experiencing at the moment.
‘This can lead to invasive and sometimes distressing treatments, without pausing to reflect on the values and wishes of the older person who is being cared for. Even when the need for end-of-life care is recognised, its delivery can challenge clinicians. Providing high-quality, person-centred end-of-life care for older people with frailty must remain a priority for all healthcare professionals, during the current pandemic and in future.’
Professor Tahir Masud, president of the British Geriatrics Society, commented: ‘At the present time, it is perhaps more important than ever that considerations and conversations around the end of life are prioritised, to help ensure that older people receive the care they want and deserve.
‘I am confident that this document, which is the first of its kind, will be of enormous value to the multidisciplinary teams who support older people with frailty at the end of their lives. It will help healthcare professionals to navigate older people and their families through this difficult time, providing care, comfort, and relief.’